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266 Cards in this Set

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If assessing cardiovascular problems skin might be
cyanotic and pale
Unusual pulsations may be present where with cardiac problems?
neck
What do the fingers look like in a person with cardiac problems?
clubbed
What position do toddlers stay in when they are having cardiac problems
squatting
What diagnosis is often associated with heart disease
failure to thrive
What might you hear in the chest with cardiac problem assessment?
thrills
What happnes to the abdomen during cardiac problems?
back up of fluids into the organs
If fluid in the lungs, what heart sounds will you hear and where?
rales at bases
When doing a cardiac assessment where do you want to take the blood pressure?
all 4 extremities
When assessing the general appearance for a child with cardiac problems what is an important aspect?
knowing the norms for each child
What cardiac diagnostic test must only be performed on older children
exercise stress test
Includes primariy anatomic abnormalities present that result in abnormal cardiac function
congenital heart disease
Congential heart disease causes what at birth?
circulatory changes
Blood flow from the left side of the heart to the right side through some abnormal opening or connection between the system or great arteries causes
increased pulmonary blood flow
ASD, VSD, Patent ductus arteriousus all cause
increased pulmonary blood flow
An obstruction or narrowing (stenosis) in a vessel or valve prohibiting enough blood from reaching its intended site is caused by
obstructive defects
Coarctation of the aorta, aortic or pulmonis stenosis are all
obstructive defects
An obstruction of pulmonary blood flow and an anatomic defect between left and right side of heart causes
decreased pulmonary blood flow
When pressure in the right side of the heart is greater than the left it causes
decreased pulmonary blood flow
Tetrology of fallot and tricuspid atresia cause
decreased pulmonary blood flow
Causes mixing of the blood from the pulmonary and systemic circulation in the heart chambers
mixed defects
Transposition of the freat vessels, total anomalous pulmonary venous connection, truncus arteriouus and hypoplastic left heart syndrome are all what?
mixed defects
The inability of the heart to pump an adequate amount of blood to the systemic circulation at nomral filling pressures to meet the metabloic demands of the body
Congestive Heart Failure
4 goals of treatment for CHF
1. Improve Cardiac function
(inc. contractility and dec. afterload)
2.Remove accumulated fluid and sodium (dec. preload)
3. dec. cardiac demands
4. improve tissue oxygenation and decrease oxygen consumption
Digoxins role in treatment of CHF
To improve cardiac function by increasing contractility and decreasing afterload
Lasixs role of treatment in CHF
Remove accumulated fluis and sodiem by decreasing preload
Meds for CHF
Digoxin and Lasix
When should you give Digoxin
At regular intervals 12 hours apart; 1 hour before meals or 2 hours after
If you miss a dose, if how many hours pass should you give at the next regular time
4
On Digoxin treatment when should you call the health care provider
If more than 2 consecutive doses have been missed or if child is ill
Can parents let thier babies with CHF cry
not for an extended period of time
How are babies with CHF fed?
NG tubes
How much activity can babies with CHF tolerate
they decide on their own
What is the most common acquired heart disease?
hyperlipidemia (hypercholesterolemia)
etiology of Kawasaki Disease
unknown but involves primarily the cardiovascular system
What is anohter name for Kawasaki disease
mucocutaneous lymph node syndrome
Manifestations of acute phase of Kawasaki
fever that stays and irritability
Manifestations of subacute phase of Kawasaki
resolution of fever
coronary artery aneurysm
Manifestations of convalescent phase of Kawasaki
symptoms have resolved at about 6-8 weeks after onset
Diagnostic Criteris of kawasaki disease
5 out of following 6 including fever:
1. fever for more than 5 days
2.red eyes
3. "strawberry tongue"
4.swollen and red extremities
5. polymorphous rash
6. lymph node >1.5 cm.
The following criteria are diagnostic for what?
1. fever for more than 5 days
2.red eyes
3. "strawberry tongue"
4.swollen and red extremities
5. polymorphous rash
6. cervical lymphadenopathy
kawasaki disease
treatment for Kawasaki Disease
gamma globulin and high doses of aspirin
What is important to remember when treating a patient with Kawasakis
take vitals every hour
Prevention of shock
wearing seat belt
Prevention of hypertension
exercise nutrition and not smoking
What is the most common form of cardiac disease in children
congeital heart disease
What prenatal afctors may predispose children to CHD?
maternal rubella, alcoholism, age older than 40, and type 1 diabetes
Clinical consequences of congenital heart defects include
CHF and hypoxemia
Clinical manifestations of CHF are:
impaired myocardial function, pulmonary congestion, and systemic congestion
Clinical manifestations of hypoxemia are:
cyanosis, polycythemia, clubbing, and delayed growth and development
The child with hypoxemia is at increased risks for
cerbrovascular accidents, brain abscess, and bacterial endocarditis
How do you prevent bacterial endocarditis in children with CHD
administering prophylactic antibiotics when procedures are performed
A systemic inflammatory disease that can damage the cardiac valves and is associated with previous group A streptoccaal infection
acute rheumatic fever
Acute rheumatic fever is associated with what previous condition
group A streptococcal infection
An extensive inflammation of small vessels and capillaries that may progress to involve the coronary arteries, causing aneurysm formation
Kawasaki disease
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: tachycardia
myocardial function
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: sweating
myocardial function
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: decreased urine output
myocardial function
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: fatigue
myocardial function
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: weakness
myocardial function
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: restlessness
myocardial function
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: anorexia
myocardial function
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: pale,cool extremeities
myocardial function
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: weak peripheral pulses
myocardial function
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: decreased blood pressure
myocardial function
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: gallop rhythm
myocardial function
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: cardiomegaly
myocardial function
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: tachypnea
pulmonary congestion
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: dyspnea
pulmonary congestion
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: retractions
pulmonary congestion
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: flaring nares
pulmonary congestion
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: exercise intolerance
pulmonary congestion
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: orthopnea
pulmonary congestion
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: cough, hoarseness
pulmonary congestion
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: cyanosis
pulmonary congestion
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: wheezing
pulmonary congestion
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: grunting
pulmonary congestion
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: weight gain
systemic congestion
Impaired Myocardia function, pulmonary congestion or systemic venous congestion:hepatomegaly
systemic congestion
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: peripheral edema
systemic congestion
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: ascites
systemic congestion
Impaired Myocardia function, pulmonary congestion or systemic venous congestion: neck vein distention
systemic congestion
Right-sided failure causes
systemic venous congestion
Left-sided failure causes
pulmonary congestion
O2 consumption of a child is ___ than that of an adult
greater
Children loss fluid ___ than adults
quicker
Children have __ antibodies than adults
less
What assessments need to be included in the respiratory function assessment of a child
GI and occasionally cardiac and neuro
How do you ease respiratory effort in children with respiratory problems?
warm or cool mist
How do you promote comfort in children with respiratory problems
blow nose, nose drops w aspirator and tylenol
How do you prevent spread of infection in children with respiratory problems
Hand washing
Why do you want to discourage milk when promoting hydration in children?
milk increases flem
When do you give a child Pedialite?
before 6 months of age
Upper respiratory infections consist primarily of
the nose and pharynx
lower respiratory infections consist primarily of
the bronchi, bronchioles, alveoli, and trachea
Croup syndromes include
the epiglottis and larynx
Pharyngitis is aka
strep throat
80-90% of pharyngitis is caused by
Group A B-hemolytic streptococci
If pharyngitis is caused by strep children are at risk for developing
acute rheumatic fever and acute glomerulonephritis
If viral in origin how do you treat pharyngitis
treat symptoms only
If positive culture pharyngitis how do you treat?
antibiotics
When are children with pharyngitis no longer contagious?
With 24 hours of antibiotics and afebrile
How do you treat tonsillitis?
antibiotics if bacterial
Indicated for recurrent strep infections, hx of recurrent peritonsillary abscess, or hypertrophy causing breathing difficulties
tonsillitis
Indicated if obstruction of nasal passageway
Adenoidectomy
Post-Op priorities for tonsillectomy
place on side
assess for bleeding and swelling shut of airway
What is common after a tonsillectomy
dehydration
An inflammation of the middle ear without reference to etiology or pathogenesis
Otitis Media
How long does acute otitis media last?
~ 3 weeks
an inflammation of the middle ear in which a collection of fluid is present in the middle ear space
Otitis Media with effusion
How long does chronic otitis media with effusion last
beyond 3 months
AOM is frequently caused by
streptococcus pneumonia and haemophilus influenzae
Otitis Media is primarily the result of
dysfunctioning eustachian tubes
What is tympanometry?
measures the movement of the eardrum---fluid in middle ear decreases movement
When should you do a hearing evaluation in otitis media?
if child has fluid in both middle ears for a total of 3 months
Antibiotic for otitis media only if
child has had more than three ear infections in the past year, positive respiratory culture, or at risk for bacterial infection
What antibiotic do you use for otitis media?
amoxicillin
Surgical incision in the ear drum that drains fluid form the middle ear
myringotomy
Why is it better to use antibiotic ear drops rather than oral for otitis media?
there is not as much blood supply in the middle ear
What is the most common croup syndrome?
acute laryngotracheobronchitis
Acute Laryngitis presentation
hoarseness and systemic manifestations
General term applied to a symptom complex characterized by hoarseness, a resonant cough described as "barking" or "brassy"
Croup syndrome
Croup syndrome is caused by
swelling or obstruction in the resion of the larynx
Croup syndrome will have varying degrees of
inspiratory stridor and respiratory distress
Therapeutic management of croup syndrome
maintaining airway with cool mist humidifier and providing for adequate respiratory exchange also maintain hydration
How long does racemic epinephrine last?
2 hours
what is important to know about racemic epinephrine?
there is a risk for rebound
Is respiratory rate is over 160 in children with respiratory problems....
NPO- risk for aspiration!
What are signs and symptoms of impending airway obstruction?
increase or decrease in noises
Three parts to respiratory assessment
1.retractions
2.lung sounds
3. equality
Sigsn and symptoms of acute epiglottis
dysphonia
dysphagia
drooling
distressed respiratory effort
How can you tell a child with acute epiglottis is in ditress?
look sick sitting upright with chin poked out
When should throat inspection for acute epiglottis be performed?
Only when immediate intubation can be performed
How does throat look in acute epiglottis?
red and inflamed with large swollen epiglottis
What is the treatment for acute epiglottis?
antibiotics, intubation and tracheotomy
How can you prevent acute epiglottis
HIB Vaccine
What lower airway infetion is not as common in children?
bronchitis
What is the common "cold"
respiratory syncytial virus
What causes respiratory syncytial virus?
mucus and swelling
Treatment for RSV?
suctioning and Ribaviron in extreme cases
RSV is rare in children
over 2
Prevention of RSV
IV RSV immune globulin or Synagis
When do you give Synagis?
once a month during high risk months
RSV may lead to
asthma
Acute inflammation in the lungs
pneumonia
S&S of pneumonia (6)
fever
unproductive -productive cough
no sounds- fine crackles
retractions
nasal flaring
pallor-cyanosis
most common cause of pneumonia
virus
Acute respiratory infection caused by Bordetella pertussis
pertussis
S&S of pertussis
continuous cough and cannot catch thier breath
Is pertussis contagious?
very
Treatment for pertussis
erythromycin
Cause of tuberculosis
Myobacterium tuberculosis
Proliferation of epithelial cells surround and encapsulate the mutiplying bacilli in an attyempt to wall it off
tuberculosis
Mantoux test is
Purified protein derivative
Positive PPD
pt has been infected and developed sensitivity but may not have active disease
Treatment for TB
Isoniazid, Rifampin and Pyrazinamide combo
TB regimen
INH, Rifampin, ad PZA daily for first 2 months........ and INh and Rifampin given twice weekly for the remaining 4 months
Prevention of TB
avoid infected and unpasteurized milk
What is gastric washing?
aspiration of contents from fasting stomach to test for TB
Chronic inflammatory disorder of the airways
asthma
What is the most common chronic disease in childhood?
asthma
Pathphysiology of asthma
mucus membranes infalme which leads to airway constriction
What is used to relieve bronchospasm in asthma
Nebulizer or MDI (Albuterol or Preventil)
How do you use an MDI correctly?
1 puff....wait one minute...take second puff
Peak flow meters assess
peak expiratory flow rate
When should they use peak flow meters?
on a dialy basis
Green PEFR
80-100%
Yellow PEFR
50-80%
Red PEFR
<50%
If O2 sats under 90%
put on 2 liters of oxygen
How often do you assess and take vitals in asthma patients
every hour and before and after treatments
If child is using face mask what should the O2 be set on
no less than 5 l.
When should a spacer be used?
recommended for everyone
At what age can a child handle a mouthpiece instead of a mask?
5-7 yrs
How long does it take to administer a nebulizer treatment?
~20 minutes
Effectiveness of nebulizer
they do not get 100% of med.
An agitated child who suddenly becomes quiet is a sign of
resp. distress
Unrelenting severe respiratory distress and bronchospasm in an asthmatic child, which persist despite pharmacologic and supportive interventions
status asthmaticus
When do you admit a status asthmaticus to ICU
siginifcant hypoxemia (less than 90 O2)
hypercarbia
peak expiratoty flow rate <25%
How do you treat status asthmaticus
continuous nebulized albuterol and IV meds such as cortocosteroids and aminophylline
Autosomal recessive disease that affects the repiratory and GI systems
cystic fibrosis
pathophysiology of cystic fibrosis
increased mucus production in lungs and GI tract
Cystic fibrosis interventions
aerosal therapy, CPT and postural drainage, IV antibiotics, and oxygen if needed
Home care for cystic fibrosis
high calorie and protein diet
pancreatic enzymes and vitamins
home IV and drainage systems
Cystic fibrosis prognosis
30 to 40 years max
What is the leading cause of death for infants beyond the neonatal period?
SIDS
What is the most common inherited disease in children?
cystic fibrosis
possible link to SIDS
prone sleeping position
Group of chronic disorders characterized by impaired movement and posture
cerebral palsy
When does cerebral palsy first appear?
first few years of life
Causes of cerebral palsy
infection
jaundice
stroke in newborns
RH incompatibility
long periods of asphyxia
What would you find during a neuro exam of an infant with cerebral palsy
persistence of neonatal reflexes
What are the different forms of cerbral palsy?
spastic, dyskinetic or athetoid, ataxic, and mixed
What form of cerbral palsy has muscle stiffness, scissors gait, weakness, hemaparetic factors, and impaired fine and gross motor skills
apstic
What form of cerbral palsy has uncontrolled slow movements, and speech problems?
dyskinetic or athetoid
What form of cerbral palsy has poor coordination, wide based gait, intention tremors, and poor sense of balance and depth perception
ataxic
Mixed forms of cerebral palsy consist primarily of what two forms?
spasticity and athenoid
In what nuero disorder do children usually have no other associated medical disorders and no mental impairment
cerbral palsy
Pharmacological therapy for cerebral palsy
Baclofen, Botox and seizure meds
What is Botox used for?
treats spasticity of muscles in cerebral palsy
Non bacterial, nontoxic purified form of the toxin that causes botulism
Botox
Chemical structure like GABA which prevents spasticity
Baclofen
How is Botox given
IM
What is Baclofen used for
Cerbral palsy
How do you give Baclofen
Po and intrathecal pump
What are the side effects of Baclofen
overly loose muscles, sleepiness, N/V, headache, dizziness
possible surgery for Cerebral palsy
dorsal root rhizotomy
Other major problems associated with cerbral palsy
bladder/bowel control
drooling
difficulty swallowing
communication
seizures
___ the children with cerbral palsy have seizures
1/2
Neural tube defect caused by failure of fetus's spine to close properly during first month of pregnancy
spinal bifida
Prevention for spina bifida
folic acid
Occulta Spina Bifida
defect is not visible externally
Meningocele Spina Bifida
encases meninges and spinal fluid but no neural elements
Myelomeningocele Spina Bifida
contians meninges, spinal fluid, and nerves
Where is Bina bifida most often lcated
lumbar region
Spina bifida is associated with?
hydrocephalus
If exam of meningeal sac is transcluscent what type of spina bifids is it most likely?
meningocele
What do you do when newborn presents with spina bifida?
keep in prone position, warm sterile saline dressing on site, NPO, administer antibiotics, bonding
With spina bifida you would want to assess for?
increased ICP
infection
anal wink
motor defects
When would you have a neurogenic bladder with spina bifida?
low nerve intervention between S1 and S2
How would you correct neurogenic bladder?
vesicostomy
and bladder augmentation
What would you use for the artificial sphincter in bladder augmentation?
appendix
How would you correct bowel problems?
continent cecostomy
All Spina Bifida patients are place on what kind of precaution?
latex
genetic origin in which there is gradual degeneration of muscle fibers
muscular dystrophies
treatment of muscular dystrophies
mainyl supportive measures
late signs of increased ICP
no pupil reaction and poor posturing
Increased CSF in the brain
hydrocephalus
hydrcephalus can be aquired by
meningitis or trauma to the brain
What is the typical shunt used to for hydrocephalus
VP
How do shunts work with hydrocephalus
drain excess fluid into peritineum and is reabsorbed
revision of VP shunts should be done how often?
q 3-4 years
In untreated late hydrocephalus what sign will you see?
sunset eyes
acute inflammation of the meninges and the CNS
bacterial meningitis
definitive diagnosis of meningitis
lumbar puncture
tretament for meningitis
attack caustive agent
Do pts with meningits need to be isolated
yes if bacterial
Contraindications of lumber puncture
skin infection, CV instability, coaggulation problems
abnormal discharge odf neurons in the brain producing a sterotyped episode of abnormal behavior, feelings or motor activity
seizure
seizure precaution
pad bed, let seize, leave food in
tonic phase of seizure
relaxed look
clonic phase of seizure
scrunched look
how often are medical updates required for epilepsy patients with drivers license
6 months to 1 year until seizure-free for five years
Ortalani and Barlow tests are for assessing
hip dysplagia
deformity of the ankle and foot
congenital clubfoot
self limited juvenile idiopathic avascular necrosis of the femoral head
legg-clave-perthes-disease
entire process of legg-clave-perthes-disease lasts how long?
18 months to a few years
Treatment for legg-clave-perthes-disease
prevent damage to femoral head through casting in an abduction position
spontaneous displacement of the proximal femoral epiphysis in a posterior or inferior direction
slipped femoral capital epiphysis
cause of slipped femoral capital epiphysis
unknown but maybe growth spurt and obesity
treatment for slipped femoral capital epiphysis
shelf procedure or pinning
What is the most common spinal deformity
scoliosis
What is important to rememeber in a patient that has had harrington rod placement for scoliosis
log roll
trauma to joint that a ligament is torn or stretched
sprain
miscrospopic tear to muscle/tendon unit
strain
A fracture that can bend 45 degress before breaking
bends
Bends fracture are common in what two bones
ulna and fibula
A fracture with compression of porous bone
Buckle
Most common fracture in young children
buckle
Fracture where bone is angulated beyond limits of bending
greenstick
growth plat injuries
epiphysis injuries
Five Ps of ischemia from vascular injury
Pain
Pallor
Pulselessness
Paresthesia
Paralysis
regaining alignment and length of bone fragments
reduction
retaining alignment and length of bone fragments
immoblization
12 hour management for sports injuries
RICE or ICES
Autoimmune inflammatory disease causing inflammation of joints and tissue with an unknown cause
juvenile rheumatoid arthritis